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Economic evaluation of a dietary intervention for adults with major depression (the "SMILES" trial)

Chatterton, Mary Lou, Mihalopoulos, Cathrine, O'Neil, Adrienne, Itsiopoulos, Catherine, Opie, Rachelle, Castle, David, Dash, Sarah, Brazionis, Laima, Berk, Michael and Jacka, Felice 2018, Economic evaluation of a dietary intervention for adults with major depression (the "SMILES" trial), BMC public health, vol. 18, no. 1, doi: 10.1186/s12889-018-5504-8.

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Title Economic evaluation of a dietary intervention for adults with major depression (the "SMILES" trial)
Author(s) Chatterton, Mary LouORCID iD for Chatterton, Mary Lou orcid.org/0000-0003-4902-9448
Mihalopoulos, CathrineORCID iD for Mihalopoulos, Cathrine orcid.org/0000-0002-7127-9462
O'Neil, Adrienne
Itsiopoulos, Catherine
Opie, Rachelle
Castle, David
Dash, Sarah
Brazionis, Laima
Berk, MichaelORCID iD for Berk, Michael orcid.org/0000-0002-5554-6946
Jacka, FeliceORCID iD for Jacka, Felice orcid.org/0000-0002-9825-0328
Journal name BMC public health
Volume number 18
Issue number 1
Article ID 599
Total pages 11
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2018-05-22
ISSN 1471-2458
Keyword(s) Depression
Diet
Economic evaluation
Major depressive disorder
Nutrition
Randomised controlled trial
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
RANDOMIZED CONTROLLED-TRIAL
MENTAL-HEALTH
DISORDERS FINDINGS
COST-EFFECTIVENESS
METAANALYSIS
PREVENTION
OUTCOMES
THERAPY
DISEASE
Summary Background
Recently, the efficacy of dietary improvement as a therapeutic intervention for moderate to severe depression was evaluated in a randomised controlled trial. The SMILES trial demonstrated a significant improvement in Montgomery–Åsberg Depression Rating Scale scores favouring the dietary support group compared with a control group over 12 weeks. We used data collected within the trial to evaluate the cost-effectiveness of this novel intervention.

Methods
In this prospective economic evaluation, sixty-seven adults meeting DSM-IV criteria for a major depressive episode and reporting poor dietary quality were randomised to either seven sessions with a dietitian for dietary support or to an intensity matched social support (befriending) control condition. The primary outcome was Quality Adjusted Life Years (QALYs) as measured by the AQoL-8D, completed at baseline and 12 week follow-up (endpoint) assessment. Costs were evaluated from health sector and societal perspectives. The time required for intervention delivery was costed using hourly wage rates applied to the time in counselling sessions. Food and travel costs were also included in the societal perspective. Data on medications, medical services, workplace absenteeism and presenteesim (paid and unpaid) were collected from study participants using a resource-use questionnaire. Standard Australian unit costs for 2013/2014 were applied. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in average costs between groups divided by the difference in average QALYs. Confidence intervals were calculated using a non-parametric bootstrap procedure.

Results
Compared with the social support condition, average total health sector costs were $856 lower (95% CI -1247 to − 160) and average societal costs were $2591 lower (95% CI -3591 to − 198) for those receiving dietary support. These differences were driven by lower costs arising from fewer allied and other health professional visits and lower costs of unpaid productivity. Significant differences in mean QALYs were not found between groups. However, 68 and 69% of bootstrap iterations showed the dietary support intervention was dominant (additional QALYs at less cost) from the health sector and societal perspectives.

Conclusions

This novel dietary support intervention was found to be likely cost-effective as an adjunctive treatment for depression from both health sector and societal perspectives.
Language eng
DOI 10.1186/s12889-018-5504-8
Field of Research 1117 Public Health And Health Services
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2018, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30108564

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.